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Introduction: Robotic surgery is widely diffused in the surgical field and is becoming increasingly prevalent, however several aspects need more detailed assessment. One of them concerns the role of robotic liver surgery for lesions in contact with major vascular (CMV) pedicles. The aim of our study is to evaluate and compare intra and post operative outcomes in patients undergoing robotic liver resections between lesions in contact or free from major vessels.

Methods: A multicentric retrospective study was performed including 1030 patients who underwent robotic liver resection. Patients were divided into two groups according to vascular contact. Intra and post-operative outcomes were compared between the groups before and after Propensity Score Matching.

Results: After propensity score matching 889 patients were included in the study. Among these lesions, 595 were not in contact with major vessels (NCMV) and 294 were in contact with major vessels (CMV). Use of Pringle Manoeuvre was more associated with CMV resections (49.8 % vs 31.2 %, p = 0,0001). No differences in terms of operative time, conversion rate, morbidity and type of complications were observed after PSM.

Conclusion: The presents study shows how robotic surgery is a valid and safe technique also for resection of tumors close to vascular pedicles.

Background: We previously reported that an extended antibiotic mitigation pathway following pancreatoduodenectomy in patients with intermediate-/high-risk glands is associated with 83 % lower odds of clinically relevant postoperative pancreatic fistula (CR-POPF). We now describe associations between the pathway, resource utilization, and hospital charges.

Methods: We performed a retrospective cohort study of patients who underwent elective pancreatoduodenectomy with soft gland texture and fistula risk score (FRS) ≥3 who received standard or extended antibiotics. Hospital charges and resource utilization within 90 days of surgery were compared by CR-POPF status and antibiotic pathway.

Results: A total of 34 patients received extended antibiotics and 53 received standard antibiotics. In patients with CR-POPF, patients who received extended antibiotics had lower likelihood of surgical or percutaneous reintervention (75.0 % vs. 100.0 %, p = 0.022). Ninety-day postoperative charges associated with CR-POPF were higher than no CR-POPF ($60,527 vs. $25,631, p = 0.028). Our risk-based model predicted a $15,825 decrease in hospital charges per patient receiving extended antibiotics.

Conclusions: CR-POPF is associated with higher 90-day hospital charges. Extended antibiotic therapy following pancreatoduodenectomy in patients with soft gland texture and FRS ≥3 is associated with fewer reinterventions in patients who develop CR-POPF. These outcomes will be formally tested in a randomized controlled trial (NCT05753735).

Aim: The primary aim of this study is to determine compliance with key quality performance indicators (QPIs) for the management of acute pancreatitis. The secondary aim is to examine the relationship between compliance to QPIs and clinical outcomes with factors that influence this.

Methods: This prospective cohort study will be conducted via the trainee-led STRATA collaborative network. All public hospitals in Aotearoa New Zealand will be eligible to participate. Data will be collected on all adult patients who are diagnosed with acute pancreatitis over a 3 month period. The primary outcome is compliance with the QPIs for the different domains of acute pancreatitis management. Secondary outcomes include early (30-days from index admission) clinical outcomes including incidence of locoregional complications, interventions, organ failure, and mortality.

Conclusion: This protocol describes the methodology for a nationwide prospective cohort study in Aotearoa New Zealand to evaluate compliance based on QPIs derived from the literature. These data will lay the foundation for future registry studies, clinical trials, and quality improvement initiatives.

Importance: Choledocholithiasis is a potentially life-threatening manifestation of acute biliary dysfunction (ABD) often requiring magnetic resonance cholangiopancreatography (MRCP) for diagnosis when standard investigation findings are inconclusive. Machine learning models (MLMs) may offer alternatives to diagnose choledocholithiasis.

Objective: This systematic review seeks to evaluate the performance of MLMs in predicting choledocholithiasis and to compare this performance with the American Society of Gastrointestinal Endoscopy (ASGE) guidelines.

Review: This review adhered to PRISMA guidelines. Four databases were searched for relevant records published between January 2000 and April 2024. Two researchers appraised records. MLM performance and ASGE guideline efficacy were compared, and the clinical utility of MLMs was assessed.

Findings: 408 records were screened; eight were eligible. Model accuracy ranged from 19 % to 97 %. Several records demonstrated a moderate-to-high risk of bias; of those featuring low risk of bias, peak accuracies ranged from 70 % to 85 %. Most MLMs outperformed ASGE guidelines. Important predictor variables included age, total bilirubin, and common bile duct diameter.

Conclusions: MLMs outperform ASGE guidelines in predicting choledocholithiasis. Nonetheless, biases in study design and reporting limit their prospective applicability. Current MLMs do not yet rival MRCP in detecting choledocholithiasis. Future guideline development should consider MLM-driven insights for better risk prediction.

Background: Robot-assisted pancreaticoduodenectomy (R-PD) helps further improve the safety and efficacy of minimally invasive pancreaticoduodenectomy. However, it faces challenges such as high costs and limitations in availability at different centers, making it difficult for patients to access. In this study, we evaluate the initial experience of Artisential®-assisted PD (A-PD) and compare its perioperative outcomes with R-PD, discussing the clinical applicability of A-PD.

Methods: This study reviewed cases of R-PD and A-PD conducted between 2022 and 2023. A total of 34 patients underwent R-PD, while 26 patients underwent A-PD. Statistical analysis was conducted based on factors related to the patient's surgical procedure and postoperative prognostic indicators.

Results: There were no significant differences observed between the two groups in terms of surgical factors. There were also no differences in the occurrence of postoperative complications. However, there was a significant difference in the length of hospital stay, with the Artisential® group having an average of 11.50 ± 5.54 days and the Robot group having 15.06 ± 5.34 days (p = 0.001).

Conclusions: R-PD and A-PD showed no differences in procedures or outcomes. Using a multi-articulated device is beneficial where robot use is challenging.